Existentialism in Psychiatry and Neurology: Relevance in Practice through Cases
D. Brendan Johnson, MD, Brigham and Women's Hospital, John Rhee, MD, MPH, Dana Farber Cancer Institute, and John Peteet, MD, Brigham and Women's Hospital
Existential concerns, such as those concerning one's purpose or identity, are important in medicine but especially relevant to the fields of psychiatry and neurology. Existentialism once served as a meeting point for theology, politics, and mental health, even if its role in medicine was somewhat buried by late-20th and 21st Century focuses on brain science, manualized therapies, virtue ethics, or even social justice. Does existentialism have any relevance today? Can it help to catalyze a reimagined medicine? As practitioners of psychiatry and neurology, we believe it does and it can, especially in its promotion of virtues in patients and practitioners alike.
This talk explores the role of existentialism through two cases, one from psychiatry and one from neurology, as well as a brief tour through existentialism's interdisciplinary history. The case from psychiatry, drawn from Basal Exposure Therapy (BET) in Norway, involves treating existential suffering thought to be behind the mental suffering of some of psychiatry's sickest patients. The case from neurology raises questions of personal identity in the context of breakdown due to neurodegenerative disease. In each of these situations, patients and clinicians grapple with existential suffering in a way that develops growth in virtue. These cases exemplify the virtues of courage and dependency, as understood through Catholic thinkers Marsha Linehan and Alasdair MacIntyre, as well as the creativity and humility developed in clinicians. Finally, we situate these contemporary examples in the longer history of existentialism and medicine, such as it appears in 12-step programs, Viktor Frankl's 'logotherapy', and new meaning- and flourishing-focused therapies.
This talk explores the role of existentialism through two cases, one from psychiatry and one from neurology, as well as a brief tour through existentialism's interdisciplinary history. The case from psychiatry, drawn from Basal Exposure Therapy (BET) in Norway, involves treating existential suffering thought to be behind the mental suffering of some of psychiatry's sickest patients. The case from neurology raises questions of personal identity in the context of breakdown due to neurodegenerative disease. In each of these situations, patients and clinicians grapple with existential suffering in a way that develops growth in virtue. These cases exemplify the virtues of courage and dependency, as understood through Catholic thinkers Marsha Linehan and Alasdair MacIntyre, as well as the creativity and humility developed in clinicians. Finally, we situate these contemporary examples in the longer history of existentialism and medicine, such as it appears in 12-step programs, Viktor Frankl's 'logotherapy', and new meaning- and flourishing-focused therapies.